Web-based prescription of smoking-cessation therapy feasible, effective

An intervention that utilized smoking-cessation therapy prescribed over the internet was feasible and effective, according to data published in Drug and Alcohol Dependence.

“The era of technology-based clinical research is certainly upon us. This large-scale trial illustrates how an internet-enabled smoking cessation program was able to reach individuals who smoke all across Ontario, whilst maintaining the clinical effectiveness of two first-line smoking-cessation medications: varenicline and bupropion,” Laurie Zawertailo, MD, senior scientist, Campbell Family Mental Health Research Institute and Addictions Division at the Centre for Addiction and Mental Health (CAMH) in Toronto, told Healio.

The researchers conducted the open-label, randomized controlled Medication Aids for Tobacco Cessation Health (MATCH) study, which was exclusively internet-based. The study included 964 current smokers in Ontario, Canada. Participants were randomly assigned via the internet to receive varenicline 1 mg (Pfizer; n = 499; mean age, 47 years; 45.5% men) or bupropion 150 mg (GlaxoSmithKline; n = 465; mean age, 46 years; 42.9% men) for 12 weeks. The medication was sent to participants via mail.

The primary outcome was 7-day point prevalence abstinence, which was defined as no cigarette puffs in the past 7 days at 12 weeks. Secondary outcomes included 7-day point prevalence abstinence at 4, 8, 26 and 52 weeks during follow-up.

“We knew from previous epidemiological data that the major barriers to receiving evidence-based pharmacotherapy for smoking cessation was accessibility and cost,” Zawertailo told Healio. “We wanted to address this gap and design a free online program that would be able to reach and treat Ontarians in need of these services.”

The 7-day point prevalence abstinence was 30.3% among participants in the varenicline group compared with 19.6% in the bupropion group at 12 weeks (OR = 2.08; 95% CI, 1.49-2.9; P < .001).

The varenicline group also had higher 7-day point prevalence abstinence at 3 weeks (OR = 1.71; 95% CI, 1.23-2.4; P = .0001) and 8 weeks of follow-up (OR = 1.95; 95% CI, 1.43-2.67; P < .001) compared with the bupropion group. However, the varenicline group did not demonstrate higher 7-day point prevalence abstinence at posttreatment follow-up at 8-, 26- and 52-weeks.

In addition, researchers observed more adverse events, including vivid dreams (59% vs. 36.3%; P < .001), fatigue (48.1% vs. 35.8%; P = .03) and nausea (52.7% vs. 20.6%; P < .001), among participants in the varenicline group compared with the bupropion group.

“The primary findings were in line with what was expected from these medications. What was surprising, however, was the heterogeneity of the participants that we reached, especially within smaller rural communities. This is important because traditional in-person clinical trials usually take place in large urban academic hospitals, precluding the participation of more rural populations,” Zawertailo told Healio.

The results of this study could be used to inform the design of future web-based medication trials for smoking cessation, according to the researchers.

“Unfortunately, even with effective pharmacotherapies, long-term smoking cessation remains a roadblock for many smokers,” Zawertailo said. “We need more research to identify the risk factors for relapse and how to combat it.”